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This is a case of a patient who presented

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with a submandibular region mass.

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When you look at the CT scan through

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the head and neck region,

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you see that we have a very large mass,

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which appears to extend below the level

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of the mandible. Hence,

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it was felt to be a submandibular mass.

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What you see here is the submandibular gland.

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So this was not a submandibular mass that

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was within the submandibular gland,

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but a mass that's posterior to the submandibular gland.

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And in point of fact,

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extends all the way up into the parotid gland.

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You notice that the lesion has cystic components

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as well as solid components.

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And not only that,

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but you see some subcutaneous spread into the

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platysma muscle on the right side,

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as well as the subcutaneous fat.

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So this very large lesion with irregular borders

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spread to the platysma muscle,

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spread into the subcutaneous fat

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is one that we would suggest represents a malignancy,

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even though it does have some cystic component.

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Now, is this cystic or is this necrotic?

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Looks a little bit more necrotic

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based on the border here.

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Pay attention as I scroll superiorly.

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What do you see? Well,

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I see some component which is appearing to go

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into the deep lobe or deep portion

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of the parotid gland.

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And I see tissue which is extending from the

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parotid gland posteriorly to the stylomastoid

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foramen. This area should have nice, clean fat.

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And instead, we have this heterogeneous swath of

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tissue extending to the stylomastoid foramen.

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This is a marker for potential spread to

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the facial nerve via perineural spread.

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Mucoepidermoid carcinomas generally have a low

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rate of perineural spread but this is an example

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of one that did spread in that fashion.

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Let's look at the coronal and sagittal images

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and see whether we're convinced. Well,

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it's pretty easy to convince yourself that this

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is a lesion of the parotid gland, given that

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it's in close opposition thereof.

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Here is the submandibular gland

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being displaced downward.

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We see this haziness even to the

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sternocleidomastoid muscle and the

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adjacent subcutaneous fat.

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And as we watch it go further superiorly,

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we see this tissue that is going right

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to the stylomastoid foramen here,

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this irregular tissue.

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Here's the clean stylomastoid foramen.

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This may be more or less convincing on the sagittal scan.

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So on this sagittal scan,

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we got this big old mass in the parotid

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gland with irregular borders,

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subcutaneous fat infiltration.

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And as we come to the

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superior border of it,

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we see that it goes to the edge of the

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stylomastoid foramen on the sagittal scan as well.

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So this was a mucoepidermoid carcinoma.

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In this case, high-grade mucoepidermoid carcinoma,

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which has potential for poor prognosis.

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You're going to look for lymphadenopathy.

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We see lymph nodes here that are enlarged.

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The patient has some large lymph nodes

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on the contralateral side.

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We probably deserve getting a PET scan to see

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how many of these are actually

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infiltrated with tumor,

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particularly if it's a high-grade

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mucoepidermoid carcinoma.